1. Hematoma formation2. Granulation:Days 3-143. Callus: New, but unorganized bone matrix4. Ossification: From week 3 to 6 monthsHealing complete, but not totally stable5. Consolidation: Healing confirmed by x-ray6. Remodeling: Completion may take up to a year

Apply ice directly over fracture site for first 24 hoursCheck with health care provider before getting fiberglass wetDry cast after exposure to waterElevate extremity above level of heart for first 48 hoursMove joints above and below cast regularlyReport signs of possible problems to health care providerKeep appointment to have fracture and cast checked

What are the "Dont's" of cast care?

DON'TGet plaster cast wetRemove any paddingInsert any objects inside castBear weight on new cast for 48 hours Not all casts are weight-bearing Cover cast with plastic for prolonged periods

What is compartment syndrome?

Elevated intracompartmental pressure within a confined myofascial compartmentCompromises neurovascular function of tissues within that space

What can cause compartment syndrome?

Restrictive casts, splints, dressingsSwelling, internal bleeding

what are the 6 P's of impending compartment syndrome?

Paresthesia: Numbness and tinglingPain: Distal to injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through compartmentPressure: ↑ in compartmentPallor: Coolness, and loss of normal color of extremityParalysis: Loss of functionPulselessness: Diminished/absent peripheral pulses

What renal complication can compartment syndrome cause and how does it come about?

Do not elevate extremity above heart levelElevation may raise venous pressure and slow arterial perfusionDo not apply cold compresses May result in vasoconstriction and exacerbate compartment syndromePressure must be relievedRemove or loosen bandage or bivalve castReduction in traction weight may ↓ external circumferential pressuresSurgical decompression may be necessary

What can lead to venous thrombosis?

Incorrectly applied casts or tractionLocal pressure on a veinImmobility

Fat globules from fracture are distributed into tissues and organs after a traumatic skeletal injury Enter circulation and lodge in: Lungs. Brain, HeartKidneys, SkinContributory factor in many deaths associated with fractures*Most common in fractures of long bones, ribs, tibia, and pelvis

Treatment is directed at preventionCareful immobilization of a long bone fracture is probably the most important factor in preventionManagement is essentially symptom-related and supportive Most survive

While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for admission. The nurse expects the patient to relate which of the following responses to this question?

The nurse is caring for a patient with osteoarthritis who is about to undergo total left knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which of the following in the preoperative period?

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old patient following left total knee replacement. Which of the following would be an appropriate nursing intervention for this patient?

A) Promote vitamin D and calcium intake in the diet.B) Provide passive range of motion to all of the joints q4hr.C) Encourage isometric quadriceps-setting exercises at least qid.D) Keep the left leg in extension and abduction to prevent contractures.

C) Encourage isometric quadriceps-setting exercises at least qid.

The nurse is caring for a 76-year-old man who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively the nurse expects which of the following will be included in the care of the affected leg?

A) Progressive leg exercises to obtain 90-degree flexionB) Early ambulation with full weight bearing on the left legC) Bed rest for 3 days with the left leg immobilized in extensionD) Immobilization of the left knee in 30-degree flexion for 2 weeks to prevent dislocation

A) Progressive leg exercises to obtain 90-degree flexion

The nurse is caring for a 75-year-old woman who underwent left total knee arthroplasty and has a new physician order to be "up in chair today before noon." Which of the following actions would the nurse take to protect the knee joint while carrying out the order?

A) Administer a dose of prescribed analgesic before completing the order.B) Ask the physical therapist for a walker to limit weight bearing while getting out of bed.C) Keep the continuous passive motion machine in place while lifting the patient from bed to chair.D) Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting

D) Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting

The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to do which of the following?

A) Avoid crossing his legs.B) Use a toilet elevator on toilet seat.C) Notify future caregivers about the prosthesis.D) Maintain hip in adduction and internal rotation.

D) Maintain hip in adduction and internal rotation.

The nurse interprets that which of the following prescribed medications is being used to treat osteomyelitis for a 54-year-old patient admitted to the nursing unit?

During a public health screening day, which of the following assessment findings would alert the nurse to the presence of osteoporosis in a 61-year-old female?

A) The presence of bowed legsB) A measurable loss of heightC) Poor appetite and aversion to dairy productsD) The development of unstable, wide-gait ambulation

B) A measurable loss of height

The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patien admitteto the hospital. In reviewing this disorder, the nurse explains which of the following to the patient?

A) With a family history of osteoporosis, there is no way to prevent or slow bone resorption.B) Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.C) Estrogen replacement therapy must be maintained to prevent rapid progression of the osteoporosis.D) Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

D) Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been most successful when the patient selects which of the following highest-calcium meals?

A) Chicken stir-fry with 1 cup each onions and snap peas, and 1 cup of steamed riceB) Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an appleC) A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milkD) A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit

The nurse is caring for a 49-year-old patient admitted to the nursing unit with osteomyelitis. Which of the following symptoms will the nurse most likely find on physical examination of the patient?

A) Nausea and vomitingB) Localized pain and rednessC) Paresthesia in the affected extremityD) Generalized bone pain throughout the leg

B) Localized pain and redness

A 54-year-old patient with acute osteomyelitis asks the nurse how this problem will be treated. Which of the following responses by the nurse is most appropriate?

A) "Oral antibiotics are often required for several months."B) "Intravenous antibiotics are usually required for several weeks."C) "Surgery is almost always necessary to remove the dead tissue that is likely to be present."D) "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."

B. "Intravenous antibiotics are usually required for several weeks."

A 67-year-old patient hospitalized with osteomyelitis has an order for bed rest with bathroom privileges with the affected foot elevated on two pillows. The nurse would place highest priority on which of the following interventions?

A) Ambulate the patient to the bathroom every 2 hours.B) Ask the patient about preferred activities to relieve boredom.C) Allow the patient to dangle legs at the bedside every 2 to 4 hours.D) Perform frequent position changes and range-of-motion exercises.

D) Perform frequent position changes and range-of-motion exercises.

The nurse identifies a nursing diagnosis of pain related to muscle spasms for a 45-year-old patient who has low back pain from herniated lumbar disk. Which of the following would be an appropriate nursing intervention to treat this problem?

A) Provide gentle range of motion to the lower extremities.B) Elevate the head of the bed 20 degrees and flex the knees.C) Place the bed in reverse Trendelenburg with the feet firmly against the footboard.D) Place a small pillow under the patient's upper back to gently flex the lumbar spine.

B) Elevate the head of the bed 20 degrees and flex the knees.

The nurse is admitting a patient who complains of a new onset of lower back pain. To differentiate between the pain of lumbar herniated disk and lower back pain from other causes, which of the following would be the best question for the nurse to ask the patient?

A) "Is the pain worse in the morning or in the evening?"B) "Is the pain sharp or stabbing, or burning or aching?"C) "Does the pain radiate down the buttock or into the leg?"D) "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"

C) "Does the pain radiate down the buttock or into the leg?"

The nurse is admitting a 45-year-old patient to the nursing unit with a history of herniated lumbar disk and low back pain. In completing a more thorough pain assessment, the nurse would ask the patient if which of the following items aggravates the pain?

A) Bending or liftingB) Application of warm moist heatC) Sleeping in a side lying positionD) Sitting in a fully extended recliner

A) Bending or lifting

The nurse has reviewed proper body mechanics with a 45-year-old patient with a history of low back pain caused by a herniated lumbar disk. Which of the following statements made by the patient indicates a need for further teaching?

A) "I should sleep on my side or back with my hips and knees bent."B) "I should exercise at least 15 minutes every morning and evening."C) "I should pick up items by leaning forward without bending my knees."D) "I should try to keep one foot on a stool whenever I have to stand for a period of time.

C) "I should pick up items by leaning forward without bending my knees."

12. Which of the following nursing interventions is most appropriate when turning a patient following spinal surgery?

A) Placing a pillow between the patient's legs and turning the body as a unit.B) Having the patient turn to the side by grasping the side rails to help turn over.C) Elevating the head of bed 30 degrees and having the patient extend the legs while turning.D) Turning the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed

A) Placing a pillow between the patient's legs and turning the body as a unit.

The nurse is planning health promotion teaching for a 45-year-old patient with asthma, low back pain from herniated lumbar disk, and schizophrenia. The nurse determines that which of the following would be the best exercise to include in an individualized exercise plan for the patient?

A) YogaB) WalkingC) CalisthenicsD) Weight lifting

B) walking

The nurse is caring for a patient hospitalized with exacerbation of asthma and herniated lumbar disk. Which of the following breakfast choices would be most appropriate for the nurse to encourage the patient to check on the breakfast menu?